Demographic and racial characteristics, and survival trends in pleural mesothelioma: A population based study.
Authors: Dhaval Patel, Lekha Yadukumar, Claudia M. Dourado, John Charles Leighton
Journal: Journal of Clinical Oncology (2023)

e20543 Background: Mesothelioma is a rare and aggressive type of cancer that originates from the visceral and parietal pleura. Approximately 3,000 people are diagnosed with mesothelioma in the United States each year ( &lt; 0.03% of all cancers). The prognosis is poor, with a 5-year survival rate of only 7 to 10%. With a latency period of 30 to 60 years, mesothelioma is typically diagnosed at an advanced age. Our objective is to investigate the demographic and racial factors that affect prognosis and survival rates in patients with pleural mesothelioma. Methods: We conducted a retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database. Socioeconomic and racial factors in 13,166 patients diagnosed with mesothelioma from 2000 to 2019 were analyzed using the Pearson chi-square test. Cancer-specific survival outcomes were compared across racial and ethnic factors using the Kaplan-Meier analysis. Results: The patients were predominantly male (78.3%) and White (91.3%). Gender-based differences were narrower among the Asian/Pacific Islander population (74.5% male vs. 25.5% female) and Black population (76.8% male vs. 23.2% female) compared to Whites (78.5% male vs. 21.5% female). In the Asian/Pacific Islander population, 59.7% of patients were diagnosed with mesothelioma after 2010, compared to 40.3% diagnosed before 2010 (p-value &lt; 0.001). Of the 12,029 new mesothelioma diagnoses in the White population, 51.6% occurred before 2010 and 48.4% after 2010. Distant disease was more prevalent in the Black population at 68%, compared to 64% in White patients and 62.3% in Asian/Pacific Islanders. Patients with a household income above $65,000 accounted for 60.8%. 57.9% of Black patients had an income below $65,000, compared to 38.9% of White patients and 23% of Asian/Pacific Islanders. At diagnosis, 51% of Black patients were married, compared to 69.5% of Asian/Pacific Islander patients and 64.5% of White patients. Chemotherapy was administered to 41.7% of patients (p-value &lt; 0.07), followed by surgery (24.5%, p-value &lt; 0.003) and radiation (10.4%, p-value &lt; 0.026). 75.8% of Black individuals did not receive treatment, compared to 71.6% of Asian/Pacific Islanders and 70.1% of White patients (p-value &lt; 0.001). The cumulative incidence of mesothelioma-related death was 70.2%. The 1-year, 3-year, and 5-year survival rates for Black patients were 29%, 5%, and 1% respectively; for White patients, the rates were 33.2%, 6.5%, and 2.1%; and for Asian/Pacific Islander patients, the rates were 31%, 6%, and 2%. Conclusions: Our study highlights the interplay of socioeconomic and racial factors that may impact survival trends. Black patients have a poorer survival rate compared to White and Asian/Pacific Islander populations. This disparity could be attributed to several factors such as later stage diagnosis, lower marital status, household income, and reduced access to treatment options.